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Objectives  Recent studies have suggested that students may experience high levels of paranoia. This study aimed to explore both experiences of paranoia and coping strategies in students scoring at high levels on a measure of paranoia.    Design  This was a qualitative study which utilized a quantitative measure to identify potential participants.    Methods  From an overall sample of 174 London‐based university students in the United Kingdom, a sub‐sample of 31 students with the highest total scores on the  Green et al. Paranoid Thoughts Scale  were invited to interview resulting in interviews with seven students (six female and one male) aged between 20 and 36 ( M  = 28.14). A thematic analysis of the interview transcripts was conducted from a critical realist standpoint.    Results  Two key foci structured the analysis:  perceived causal influences on paranoia  (comprised of ‘historical contexts fostering mistrust’; ‘finding a social situation strange’; ‘anticipating threat’; and ‘evaluating the concern’) and  living with paranoia  (comprised of ‘effects on everyday life’ and ‘trying to minimize the effects of paranoia and regaining control’).    Conclusions  Key aspects of the findings discussed in the context of the literature include paranoia as a threat heuristic; the role of internal and external dialogues; the influence of gender on content; and the importance of meaning in life as a coping resource.    Practitioner points    Paranoia may be a significant issue for some students.  Paranoia needs to be seen in the context of past aversive experiences.  Dialogical approaches may be useful in developing new therapeutic narratives.  Valued social roles, activities, and responsibilities may be an important coping resource.

How is paranoia experienced in a student population? A qualitative study of students scoring highly on a paranoia measure